|
11/12/2010 14:19 2092394 3 BUSINESS OFFICPAGE 20
<br /> MCR71trAY"'WA�7 C 1 timw.K1f4 c*'1-vniw iVUMtlGK
<br /> ®® STANDARD WANIFEBTo01.10•oe-37D
<br /> •®• Stericycle' IN CASE OF ERABftGEfitl"
<br /> •® h.%MV People.RoWnp RhY; I' tt.D t e *: -'(1-3.
<br /> 1,Generator's Name,Address and Telephone.Number., j 5EAUICE IPT
<br /> ATTIC: Cathy/Maxi pi,.
<br /> -002
<br /> T+'I/4T1�MCA CWkE * .1�'J:' E1 Naanteca Care a�8ehhalo
<br /> 41.0 FASTla X4) ?VVE SERUICE ORTE! 411540 15156 PR
<br /> ON
<br /> TuINNIT:;6:A, CA 95::1;36- .316/ ORIVEA -- --- --- - -__._ II
<br /> SNIPPINGMcuKNT r: 0115899ER 4/15/201P
<br /> TOiRL CULLECTEO: 2
<br /> TOTAL UOLUNE: 11.890 CU FT
<br /> CUSTOWR NUMBER FAL)5 9 471--t•)02
<br /> 2A.DESCRIPTION OF WASTE 26. Nfla14U IB14 ONG14N 1819 2C. No.OF z®. VOLUME
<br /> ---------------
<br /> REGULATED MEDICAL WASTE,n,o,s„6.2, -- - UOL CONTAINERS
<br /> UN 3291.,Fe 11 �PSa7 1 "a '�TAb {r�ic SUNNAR4(Cmlt lype) OTV CF Cu F!
<br /> REGULATED MEDICAL WASTE,n.o.s.,6.2, Tt3j9 - 3'r G.t1 TiAb TS1t T819 44 Gal Tub(Rio)• CT 12•? 2 11.908 Cu Ft
<br /> UN 3291,PG II ---------------------
<br /> REGULATED
<br /> _ ------REGULATED MEDICAL WASTE,n.0.8.,6.2, TR14 - 44 gal Tub S01o) OELIUER4-011CUNIII 1: PUf80041ER ^, . A oti Ft
<br /> a UN 3291,PG 11 ..------- •--
<br /> REGULATED MEDICAL WASTE,n.o.s.,6.2, TB7.1 - VU Gal. Tvb(le-ie) TOtAI bflIUEREO ITEMS"2 } ' '
<br /> UN 3291,PG it Cu R
<br /> ® REGULATED MEDICAL WASTE,n.o.s.,6.2, T815 ,- 20 aAj TIM (par. TVPE OTV
<br /> UN 3291,PG 11 Cu Ft
<br /> u Toil 44 Gal 16(1110- CT 12.7 lb 2
<br /> y REGULATED MEDICAL WASTE.rl.o.s.,6.2, IIsi a� 4�hRa cu F4
<br /> UN 3291,PG•II _
<br /> REGULATED MEDICAL WASTE,n.o.s.A2, Cu Ft
<br /> UN 3291,PG II
<br /> REGULATED MEDICAL WASTE,n.o.s.,6.21 URIUER; Nantez•Mar9aritt(Marty)
<br /> UN 3291,PG 11 FREQUENCPI Ilea)
<br /> y,111
<br /> Cu.F1
<br /> FltaratacAuCf:,x7. IO�Ptt� WSI PICKUP 4CE:
<br /> CUSTOMER SERUICE Ou Ft
<br /> Thank gat for choosing Sterloyoie
<br /> 3.Generator's Certit'it anion:"I hereby declare that the contents of this cone) ` �"° r , Cu Ft
<br /> described above by the proper shipping name•and are classified,packaged.
<br /> �areda ILII respects In proper condition for transport according to applicable inli -
<br /> ���t1
<br /> Qrinted d Na
<br /> sli
<br /> 4rITSANSPORTER'1 ADDRESS: naw ..... Phdn®a: (•559�a 27.5. 09-4,4:
<br /> W S1~Gi»i.G"y01 A �T1C . Applicable Permit Numbers!
<br /> 4.135 gest Swift Avgtr ;i1.ir: it � Tncu:,ucllx ailL�tu►►�taL
<br /> :R + '
<br /> T-r�3330 r v� �a 72i
<br /> TRANSPORTER CERTIFICATION: Receipt of medial waste as described above.
<br /> Prinvl'gpe Name ' '� / ! �� Signature f � Dat® f
<br /> S.INTERMEDIATE HANDLER 2/ NSPORTER 2 ADDRESS: ° Phone#
<br /> (;J ,✓:!
<br /> Applicable PermR Numbers:
<br /> F-Q
<br /> INTERMEDIATE HANDLER/TRANSPORTER CEFTWICATION: Receipt of mackal waste as described above.
<br /> PdnMpe Name Signature Date
<br /> 6,INTERMEDIATE HANDLER 3/TRANSPORTER 3 ADDRESS: Phone R:
<br /> � - Applicable Permit Numbers;
<br /> i INTERMEDIATEHANDLER/TRANSPORTER CERTIFICATION: Receipt of medical waste as deac ribed above,
<br /> Printliype Name Signature Date
<br /> 7.DISCREPANCY INDICATION
<br /> Tkat> d cu It to : Monti SM Lake,UT
<br /> SA.Designated Faculty: 6B.Alternate Facility: []BC.Alternate Facility: 0ab.Altamsts FecIl r:
<br /> S7TERIG><GL 11"dC
<br /> STERICYCLEINC 'a'” MICYCLE INC S CYC INC
<br /> 4136 W,SWFT AVE 90 NORTH I too 1' W0 NORPIS AVE, 277.5
<br /> t FPESNOI CA 931722 NORTH SALT LAKl CRY,UT SUN VALLEY,CA 913ON,CA
<br /> (Sffi
<br /> 275.0 ESU 1)M.-i-on {8 i 19)sQ4-X27 (32.3)382-3000
<br /> i "f"331,TS T` T22 Clt 'V)ndrwratlon P 91 P-G,P-1 tis
<br /> C
<br /> TREATMENT FACILITY: I certify that I have been authorized by the applicable state agency to accept untreated medical wastes and that I have
<br /> - received the above indicated wastes in accordance with the requirement outlined in that authorization.
<br /> PrInUlype Name Signature Date
<br />
|